The flaps A, A are then brought together so that their vertical margins meet at the median line, where they are sutured. A few fine sutures are taken through the vermilion border.
A secondary wound, C, C, at either side is thus occasioned ([Fig. 246]), which can at once be covered with Thiersch grafts or is allowed to heal by granulation.
Fig. 245. Fig. 246.
Teale Method.
Where the deficiency is due to cicatricial contractions of the submental tissue the latter must be divided horizontally from one healthy border to the other, the parts freed well from all subcutaneous adhesions in the cellular structure. The head should be forcibly raised and a flap of skin be placed into the elliptical wound thus formed either by the rotation of a pedunculated neck or thorax skin flap or the implantation of Wölfler or Thiersch grafts.
Carefully keeping the head in an extended position during the healing in of these grafts will overcome the primary defect, unless the lip itself, too, has become tied down, when the bridge flap method of Morgan or Zeis can be undertaken in conjunction with the skin-grafting method to correct the fault.
LABIAL ECTROPION
Eversion of the lip may be due to cicatricial contraction of ulcerative wounds, burns, and traumatisms of the skin, or it may be hereditary. In the latter case the entire lip structure is more or less overdeveloped, as in the negro, especially in the lower lip, so that the thickened lip droops forward and downward. This condition is termed macrocheila.
Ectropion of the lower lip is more common than in the upper lip. The defect may be slight and only of cosmetic importance or it may be so extensive as to permit an overflow of the saliva from the mouth.